Diabetes progression significantly higher in diabetes patients who use statins

A new US study suggests that patients with diabetes who use a statin have a significantly higher risk of diabetes progression. Although statin therapy has been associated with increased insulin resistance, how statins affect diabetes control among patients with diabetes has been uncertain. The US trial was a retrospective matched-cohort study that used new-user and active-comparator designs to assess associations between statin initiation and diabetes progression. The study used a national cohort of patients covered by the US Department of Veterans Affairs from 2003–2015. Patients were 30 years of age or older, had been diagnosed with diabetes during the study period and were regular users of the Veterans Affairs health system. The study compared treatment initiation with statins (statin users) or with H2-blockers or proton pump inhibitors (active comparators). Of the 705,774 eligible patients, 83,022 pairs of statin users were matched to active comparators. The matched cohort had a mean age of 60.1 years and 94.9% were men; 2.1% were American Indian/Pacific Islander/Alaska Native, 0.8% were Asian, 21.5% were black individuals, 68.2 % were white individuals and the remainder were unknown (or data missing). The study compared treatment initiation with statins (statin users) or with H2-blockers or proton pump inhibitors (active comparators). Of the 705,774 eligible patients, 83,022 pairs of statin users were matched to active comparators. The matched cohort had a mean age of 60.1 years and 94.9% were men; 2.1% were American Indian/Pacific Islander/Alaska Native, 0.8% were Asian, 21.5% were black individuals, 68.2 % were white individuals and the remainder were unknown (or data missing). The investigators evaluated the diabetes progression composite outcome, comprised of new insulin initiation, increase in the number of glucose-lowering medication classes, incidence of significant hyperglycemia (five or more measurements of blood glucose of ≥ 200 mg/dL [11.1 mmol/L]), or a new diagnosis of ketoacidosis or uncontrolled diabetes. Results showed that the diabetes progression composite outcome occurred in 55.9% of statin users vs 48.0% of active comparators (odds ratio, 1.37; 95% CI, 1.35–1.40; p < 0.001). In addition, each individual component of the composite outcome was significantly higher among statin users. Secondary analysis showed a dose-response relationship with a higher intensity of low-density lipoprotein-cholesterol (LDL-C) lowering associated with greater diabetes progression. The odds of diabetes progression among statin users vs nonusers were 1.83, 1.55 and 1.45 for high-, moderate- and low-intensity cholesterol lowering, respectively. In summary, this large, retrospective matched-cohort study found that statin use was associated with diabetes progression in patients with diabetes. Statin users with diabetes had a greater likelihood of insulin treatment initiation, significant hyperglycemia and acute glycemic complications, as well as an increased number of prescriptions for different glucose-lowering medication classes. The number needed to be exposed to statins for one additional person to experience diabetes progression outcome was 13. Read: Fixed-ratio combination insulin GLP1 RA products for type 2 diabetes The authors conclude that the risk-benefit ratio of statin use in patients with diabetes should take into consideration the metabolic effects of statins. The authors note that the higher risk of diabetes progression associated with statin use may seem less consequential, at least in the short and intermediate term, than the cardiovascular benefits of statin use, especially when used for secondary prevention. However, they maintain that diabetes progression has long-term effects on quality of life and treatment burden, which warrant consideration when discussing the overall risk-benefit profile, especially when statins are being used for primary prevention. Strengths of this study were its large size and longitudinal follow-up period with detailed clinical data. Limitations are inherent to retrospective observational data; therefore, there is always a chance of unmeasured residual confounding. The study data could also not reliably differentiate between diabetes types. In addition, patients covered by the Veterans Affairs were predominantly men, which may limit generalization of the results. Reference 1. Mansi IA, Chansard M, Lingvay I, et al. Association of statin therapy initiation with diabetes progression. A retrospective matched-cohort study. JAMA Intern Med 2021; Published online October 4, 2021. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2021.5714?guestAccessKey=a3d0cc91-1e63-450e-a661-5afeddb9053a&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=100421 (accessed October 5, 2021).

Diabetes progression significantly higher in diabetes patients who use statins

Register for free access or login.

Related Topics